Eliquis side effects and drug information

Eliquis is a brand name of the prescription drug Apixaban, which is utilized to cure severe blood clots from coalescing because of a particular abnormal heartbeat and after knee/hip replacement surgery. When atrial fibrillation occurs, a specific section of the heart doesn’t beat regularly.

Eliquis 
PubChem CID10182969
ChemSpider ID8358471
Trade nameEliquis
ChEMBL Id231779
ChemSpider ID8358471
Molar mass459.497 g/mol

This can result in the formation of blood clots that can spread to various parts of the body like the legs and lungs or raise your risk of suffering from a stroke.

Moreover, apixaban is also approved as a cure for several kinds of blood clots such as pulmonary embolus-PE and deep vein thrombosis-DVT, and stop them from developing again. Generally, Eliquis is considered as an anticoagulant that operates by preventing specific clotting proteins found in your blood.

Side Effects

Information for side effects includes easy bruising, nausea, or risk of bleeding – like bleeding from cuts or nosebleed. In case any of these continue and get worse, go to your doctor for medical advice and help immediately.

Take note that if your doctor or physician prescribed you with Eliquis, he/she knows that the benefit you will get from the prescription medication is far more significant compared to the risk of side effects. Most people who utilize this don’t suffer from any severe side effects.

Eliquis can result in prolonged and unusual bleeding if it dramatically impacts the protein responsible for your clotting.

Go to your doctor right away if you’ve seen signs of severe bleeding such as:

  • swelling
  • pain
  • discomfort
  • abnormal bruising
  • frequent/persistent nosebleeds
  • prolonged bleeding from gums or cuts
  • abnormally prolonged/heavy menstrual flow
  • coughing up blood
  • dark/pink urine
  • fainting
  • unusual/persistent weakness or tiredness
  • black, bloody, or tarry stools
  • vomit that is bloody or looks like coffee grounds
  • difficulty swallowing

Seek immediate medical advice or help if you experienced any of the cues of extremely severe bleeding, such as:

  • vision changes
  • slurred speech
  • confusion
  • joint pain on one part of the body

An extremely severe allergic reaction to Eliquis is one of the rare side effects of the medication. But, you need to seek prompt medical help whenever you notice any signs of a severe allergic reaction such as:

  • skin rash, swelling or itching in the throat, tongue, or face
  • severe dizziness
  • problem breathing or wheezing

This isn’t the full information about the potential side effects of Eliquis. It is still better to go to your physician or doctor for medical advice and information about the side effects of the said prescription medication. If you happen to experience these effects, get immediate medical assistance.

Indication And Dosage

Eliquis is used to decrease the risk of systematic embolism or stroke among patients who have non-valvular atrial defibrillation or AF.

It is prescribed as a treatment for Prophylaxis of deep vein thrombosis or DVT, which might result in pulmonary embolism or PE among patients who went through hip or knee replacement surgery. It is also used to decrease the risk of recurrent PE and DVT after initial therapy.

Eliquis is in tablet form, and it comes in two strengths: 5 mg and 2.5 mg. Here’s the proper dosage information when taking the medication.

Stroke Prophylaxis 

To stop stroke and systematic embolism among patients with nonvalvular fibrillation, take 5 mg PO BID. For renal impairment or nonvalvular atrial fibrillation:

  • Mild-to-moderate – no required dosage adjustment
  • Serum creatinine ≥1.5 mg/dL – reduce dosage to 2.5 mg BID in case the patient has one extra characteristic of age ≥80 years or weight ≤60 kg
  • ESRD maintained on hemodialysis – 5 mg BID; reduce dose to 2.5 mg BID in case of 1 additional feature of age ≥80 years or weight ≤60 kg is present

Postoperative Prophylaxis of DVT/PE

Prescribed right after a hip or knee replacement surgery.

  • Initial – The patient must take 2.5 mg PO 12-24 hours before replacement surgery.
  • Duration of therapy (knee replacement) – patient must take 2.5 mg PO BI for 12 days straight
  • Duration of treatment (hip replacement) – patient must take 2.5 mg PO BI for 35 days straight
  • The renal impairment that comes with ESRD on dialysis:
  • Deep Vein Thrombosis – no recommended dose adjustment; no clinical trials or studies regarding ESRD on dialysis or patients that have CrCl <15 mL/min; dosage requirements according to pharmacodynamic and pharmacokinetic (anti-FXa activity) information acquired in study subjects with ESRD maintained on dialysis

PE or DVT Treatment

Intended for treating pulmonary embolism or PE and deep venous thrombosis or DVT. 10 mg PO BID for seven days, then 5 mg BID after.

Decrease the risk for recurrent PE or DVT:

  • 2.5 mg PO BID – indicated to decrease the risk of recurrent PE or DVT right after the first six months of treatment for PE or DVT.

Renal impairment with ESRD:

  • Deep Vein Thrombosis – no recommended dose adjustment; no clinical trials or studies regarding ESRD on dialysis or patients that have CrCl <15 mL/min; dosage requirements according to pharmacodynamic and pharmacokinetic (anti-FXa activity) information acquired in study subjects with ESRD maintained on dialysis.

Dosage Modifications

Taken with dual inhibitors of P-GP and CYP3A4:

  • If the patient is consuming 2.5 PO BID, reduce the dosage by 50%.
  • If the patient is consuming 2.5 mg BID, don’t take it with potent dual inhibitors

Nonvalvular atrial fibrillation:

  • Reduce dosage to 2.5 mg PO BID if patients have any of the two characteristics: at least 80 years of age and at least 60 kg of weight.
  • Serum creatinine – 1.5 mg/dL

Hepatic impairment:

  • Mild – doesn’t require any dosage modification
  • Moderate – patients may suffer from intrinsic coagulation abnormalities; pieces of evidence are limited, and recommendations are lacking
  • Severe – not recommended

Dosing Considerations

If you trade between Eliquis and anticoagulants aside from warfarin, stop using the one being consumed, and start the other at the incoming scheduled dosage. On the other hand, if you switch from warfarin and is now taking Eliquis, stop using warfarin and see to it that you initiate Eliquis when INR <2.0.

Trading from Eliquis to warfarin:

  • Eliquis impacts INR. That’s why accurate measurements when using it together with warfarin, may not tell the proper warfarin dosage.
  • If your doctor or physician prescribes that consuming both medications is necessary, stop using Eliquis and start taking both warfarin and a parenteral anticoagulant at the scheduled dosage for Eliquis.
  • Stop using parental anticoagulants if INR reaches the right level.

Procedures or surgery:

  • Stop taking for at least 48 hours before invasive procedures or elective surgery with a high or moderate risk of abnormal or clinically relevant bleeding.
  • Stop taking for at least 24 hours before invasive procedures or elective surgery with low risk of abnormal bleeding or in case the bleeding would take place in a non-critical and easily controlled area.

Drug Interaction

These medications should not be taken together with Eliquis since it could result in drug interaction, which alters how each drug works in the body. Talk to your healthcare professional, for example, a pharmacist or doctor, for more comprehensive information.

Serious Interactions: 

  • bivalirudin
  • celecoxib
  • cilostazol
  • clopidogrel
  • dabigatran
  • dalteparin
  • darunavir
  • abciximab
  • alteplase
  • anagrelide
  • antithrombin alfa
  • apalutamide
  • argatroban
  • desirudin
  • desvenlafaxine
  • diclofenac
  • Factor X, human
  • fenoprofen
  • flurbiprofen
  • heparin
  • dipyridamole
  • duloxetine
  • edoxaban
  • enoxaparin
  • eptifibatide
  • etodolac
  • ketorolac
  • lasmiditan
  • lepirudin
  • levomilnacipran
  • meclofenamate
  • mefenamic acid
  • meloxicam
  • milnacipran
  • ibuprofen
  • ibuprofen IV
  • idelalisib
  • indomethacin
  • ivosidenib
  • ketoconazole
  • ketoprofen
  • nabumetone
  • naproxen
  • nelfinavir
  • oxaprozin
  • phenobarbital
  • piroxicam
  • saquinavir
  • sulindac
  • tenecteplase
  • ticlopidine
  • tirofiban
  • tolmetin
  • venlafaxine
  • voxelotor
  • posaconazole
  • prasugrel
  • primidone
  • protein C concentrate
  • quinidine
  • reteplase
  • ritonavir
  • rivaroxaban

Severe Interactions

Severe side effects may be experienced with the following:

  • crofelemer
  • dabrafenib
  • daclatasvir
  • diltiazem
  • dronedarone
  • efavirenz
  • verapamil
  • vortioxetine
  • zanubrutinib
  • acalabrutinib
  • aspirin
  • caplacizumab
  • cenobamate
  • citalopram
  • elagolix
  • eliglustat
  • encorafenib
  • istradefylline
  • itraconazole
  • melatonin
  • mitotane
  • nintedanib
  • ombitasvir/paritaprevir/ritonavir
  • paroxetine
  • sarecycline
  • escitalopram
  • fedratinib
  • fish oil triglycerides
  • fluoxetine
  • fluvoxamine
  • glecaprevir/pibrentasvir
  • ibrutinib
  • iloperidone
  • imatinib
  • saw palmetto
  • sertraline
  • stiripentol
  • tecovirimat

Moderate Interactions:

The medicine is expected to have modest effects when taken with clarithromycin. To know more information about this, talk to your doctor or medical care provider.

Warnings and Precautions

Eliquis side effects like bleeding can occur when the meds are taken longer than intended, or the patients receive a dose more than what was prescribed. It is intended for short-term use only and under strict medical supervision. Do not ignore signs and symptoms, unusually heavy bleeding.

Eliquis has a black box warning since it can cause a higher risk of stroke among patients with atrial fibrillation that discontinue consuming it. That’s why it is highly recommended that you don’t abruptly stop taking this medication without consulting your doctor.

Even if you already feel well, continue drinking Eliquis, and don’t miss any dosages. If you need to discontinue using the meds, your doctor may prescribe you with another blood thinner to combat the possibility of suffering from a stroke.

Furthermore, another black box warning for Eliquis is it can cause a severe blood clot in the areas of spinal cord if the patient has spinal anesthesia or spinal puncture, epidural, or spinal puncture while consuming it. This specific blood clot can result in long-term or permanent paralysis. Talk to your doctor if you presently have or had a history of having:

  • Spinal punctures
  • Spinal surgery
  • A spinal deformity
  • Epidural catheters

Another note, it’s also essential to update your doctor if you are using any prescription medication that may impact the way your blood clots, such as:

  • Agrylin (anagrelide)
  • Aggrastat (tirofiban)
  • Coumadin or Jantoven (warfarin)
  • prasugrel
  • Persantine (dipyridamole)
  • Pletal (cilostazol)
  • Brilinta (ticagrelor)
  • Heparin
  • Integrilin (eptifibatide)
  • Plavix (clopidogrel)
  • Ticlopidine
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen), Indocin or Tivorbex (indomethacin), ketoprofen, and Aleve, Anaprox, or Naprosyn (naproxen)
  • Eliquis may also interact with particular medications that are usually taken whenever there’s a medical emergency. You or your family member must update your doctor whether or not you are taking Eliquis Apixaban, in case of an emergency medical situation. Tell your doctor immediately if you experience any of these adverse reactions while taking this medication:
  • Tingling or numbness, especially in the legs
  • Muscle weakness, especially in the feet or legs
  • Back pain
  • Loss of control of your bowels or bladder

Never consume Apixaban if you are suffering from active bleeding or an artificial heart valve. This medication may result in easy bruising or bleeding. As much as possible, avoid doing activities that may heighten your risk of injury or bleeding while taking Eliquis, Apixaban.

If you hurt yourself or are in pain, contact your doctor immediately, especially if you injure your head. Honestly tell your doctor or physician that you are taking Eliquis Apixaban before going through any dental or medical procedure.

Before you start to use this medication, tell your healthcare provider if you have or had:

  • Liver disease
  • A stroke
  • Kidney disease
  • Bleeding problems
  • Allergies to medicines

Furthermore, tell your healthcare provider if you are 80 years old or older, or if your weight ranges from 132 pounds or less. Make sure you keep all your laboratory and doctor’s appointment while taking this medication. Your doctor will likely order frequent tests to find how your body reacts to the medication.

Though Apixaban or Eliquis isn’t considered a hazard to an unborn child if consumed during pregnancy, it may raise the risk of bleeding during delivery or pregnancy. Consult your doctor and tell him/her if you are pregnant or planning to get pregnant while taking this medication. The possibility that this drug may pass on to breastmilk is not yet known. However, it is highly-suggested that breastfeeding mothers should stay away from this medication.

Overdose and Contraindications for Eliquis

Signs of Apixaban overdosage include the following:

  • Abnormal bruising or bleeding
  • Brown, red, or pink urine
  • Coughing up blood or certain material that looks like coffee grounds
  • Red, black, or tarry stools

If you think you are experiencing overdosage, call an emergency room or poison control center right away. Do not wait to experience adverse reactions or pain before going to see a doctor. Usually, bleeding or even a skin rash is a side effect and is an indication that something is wrong.

Apixaban is also contraindicated for utilization by patients that have extreme sensitivity to the medication. Be warned of the following contraindications when taking Apixaban.

  • Bleeding – Apixaban is contraindicated among patients with present pathological bleeding since the use of this medication heightens the risk of bleeding and can result in severe and potentially dangerous bleeding.
  • Abrupt discontinuation – avoid sudden stoppage of using Apixaban without sufficient alternative anticoagulation. Stopping Apixaban places patients at a higher risk of thrombotic circumstances. Increased stroke was also discovered among patients who switch from apixaban to warfarin.
  • Prosthetic heart valves – the utilization of apixaban among patients who are diagnosed with prosthetic heart valves doesn’t have any clinical trials or studies yet. However, the usage of this drug among this group of patients is not suggested.
  • Surgery – the anticoagulant impact of apixaban lasts for approximately 24 hours right after the last dosage. Stop using apixaban 48 hours before invasive producers or elective surgery. Bleeding is a risk with this kind of medication.

Clinical Pharmacology

Factor Xa inhibitor restricts platelet activation by reversibly impeding the current location of factor Xa without allowing a cofactor, such as an antithrombin III since the activity prevents clot-bound and free factor Xa, as well as prothrombinase activity. It doesn’t have any direct impact on platelet aggregation. Yet, it indirectly prevents platelet aggregation caused by thrombin extrinsic and intrinsic passages that play a vital role in terms of blood coagulation flume.

Absorption

Bioavailability: shows long-term absorption Peak Plasma Concentration for specifically 3-4 hours

Distribution

  • Vdss: 21 L
  • Protein Bound: 87%

Metabolism

  • Mainly metabolized by CYP3A4
  • Metabolized with minor help from 2J2, CYP1A2, 2C9, 2C8, and 2C19
  • Primary biotransformation sires: hydroxylation and O-demethylation located at the 3-Oxopirperidinyl moiety
  • Metabolites: doesn’t have any active circulating metabolites Substrate of BCRP and P-GP

Elimination

  • Half-life: 12 hours (apparent half-life with repeated dosage); 5-6 hours (dominant)
  • Dialyzable: No
  • Renal clearance: 27%
  • Excretion: 25% of Apixaban are secreted in urine and feces in the form of metabolites; direct and biliary excretion helps with the removal in the feces; renal excretion is about 27% of overall clearance.

Children shouldn’t consume sildenafil unless the doctor decides that it is the most suitable and effective medication to cure the child’s health complications. Viagra or Sildenafil belongs to the category of drugs that are known as phosphodiesterase (PDE) inhibitors. It treats erectile dysfunction by improving blood pressure towards the penis during sexual stimulation. With this, blood pressure is increased, resulting in a better erection. Besides, Sildenafil cures PAH by calming the blood vessels located in the lungs to enable blood to flow smoothly.

Always keep in mind that if you are consuming sildenafil to cure erectile dysfunction, it doesn’t treat erectile dysfunction nor improve sex drive. It only helps men achieve a better erection by increasing blood flow to the penis with the help of sexual stimulation. Sildenafil doesn’t prevent pregnancy nor transmit sexually transmitted diseases like human immunodeficiency virus (HIV).

Side effects

Just like any medications, Sildenafil effects can also be severe or serious. If you experience any of these adverse reactions, call your doctor right away:

  • heartburn
  • flushing (feeling of warmth)
  • difficulty falling asleep or staying asleep
  • headache
  • diarrhea
  • nosebleeds
  • muscle aches
  • sensitivity to light
  • burning, numbness, or tingling in the arms, feet, hands, or legs
  • changes in color vision (seeing a blue tone on objects or having a problem telling the difference between green and blue)

There are also Sildenafil adverse effects that can be severe. In the events that you suffer from any of the following adverse facts, call your doctor, or get emergency help right away:

  • blurred vision
  • sudden severe loss of vision (see below for more information)
  • sudden loss of hearing
  • dizziness or lightheadedness
  • ringing in ears
  • chest pain
  • worsening shortness of breath
  • the erection that is painful or lasts longer than 4 hours
  • fainting
  • heart failure
  • itching or burning during urination
  • rash

Some people experience chest pain, a sudden loss of all or some of their vision right after they consume sildenafil or other prescription medications. There are rare cases that vision loss or blurred vision was permanent. However, there are still no reported studies or clinical trials that proved that the sudden vision loss was due to Viagra. If you have abrupt vision loss while taking Viagra, contact your doctor or physician right away. Discontinue using any more dosages of Viagra, Sildenafil or other similar medications like vardenafil (Levitra) or tadalafil (Cialis) until you reach out to your doctor.

Besides this, adverse reactions such as stroke, high blood pressure, irregular heartbeat, coronary artery disease, bleeding in the lungs or brain, and sudden death among men who consumed Sildenafil to treat erectile dysfunction. The majority of these people, but not all, suffered from heart complications before drinking Viagra. It is still unknown if these circumstances were due to Viagra, heart failure, sexual intercourse, or a combination of all of these. This is because there are no studies and clinical trials reported that link Viagra into all of these. Talk to your physician or doctor about the adverse reactions of Viagra before taking it.

Furthermore, some individuals suffer from abrupt loss or decrease of hearing right after they consumed sildenafil (Viagra) or any other medications that are associated with Sildenafil. Usually, the hearing loss from Sildenafil only affects one ear and doesn’t always progress once the patient discontinues taking medicine.

It is still unknown whether the sudden hearing loss was due to Viagra since there are no clinical trials and studies that prove it. In the events that you experience abrupt hearing loss, alongside dizziness or ringing in the ears, while you are drinking Viagra or Sildenafil, contact your doctor right away. Always remember that if you are consuming Viagra, Sildenafil, and any other medications such as vardenafil (Levitra) or tadalafil (Cialis) to treat erectile dysfunction, don’t take more dosages unless your doctor says so.

On another note, if you are consuming Revatio Sildenafil to treat PAH, never discontinue your usage until you discuss it with your physician or doctor. Viagra or Sildenafil may also cause other forms of adverse reactions. So if you experience unusual symptoms while consuming Sildenafil, talk to your doctor right away. In case you experience any severe side effect, your doctor, physician, or you could send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event.

Indication and dosage

Viagra or Sildenafil is indicated for the cure of erectile dysfunction or ED. All potential drug forms and doses may not be listed here. Your drug treatment, and how often you drink the medication is solely dependent on these factors:

  • the complication being treated
  • your age
  • how severe your condition is
  • how you react to the first dose
  • other medical complications that you have

Here are the recommended dosages for taking Viagra or Sildenafil for erectile dysfunction:

  • Generic: Sildenafil
  • Form: oral tablet
  • Strengths: 100 mg, 50 mg, 25 mg
  • Brand: Viagra
  • Form: oral tablet
  • Strengths: 100 mg, 50 mg, 25 mg

Here are the recommended dosages for patients that are 18-64 years old:

  • Minimum dosage: 50 mg consumed as needed approximately 1 hour before sexual intercourse. It can be consumed 30 minutes to 4 hours before any sexual activity.
  • Maximum dosage: 100 mg once a day

For children ages 0 to 17 years old:

  • Viagra or Sildenafil hasn’t confirmed whether or not it is useful or safe for children below 18 years old.

For patients that are 65 years and older:

The heart, liver, and kidneys of older individuals taking Sildenafil might not function as high as they used to. With this organ impairment, their body would have difficulties processing the medications. This often leads to a more significant amount of Sildenafil drug accumulation in their body that stays there for a prolonged period. When this happens, their risk of suffering from adverse reactions might increase. For seniors, doctors or physicians might decrease the dosage of Sildenafil to prevent higher levels of drugs from accumulating in the body.

Drug Interaction

Sildenafil oral tablet can interact with other types of medications, supplements, vitamins, and herbs that you might be consuming. Sildenafil Interaction happens when a substance alters the mechanism of a particular drug. When an interaction occurs, this can be hazardous or impeded the medication from taking its full potential. To prevent interactions from happening, you should only allow your physician or doctor to handle all your drugs, especially Sildenafil. Make sure you inform them about the all vitamins, medications, and supplements that you are consuming. You should also ask your pharmacist or doctor how Viagra or Sildenafil might interact with any medication, vitamins, supplements, or herbs that you’re taking.

Here are examples of drugs that can result in interactions with Viagra or Sildenafil.

Do not consume these drugs alongside sildenafil. Taking these can lead to hazardous adverse reactions in the body.

Examples of these drugs are:

  • Nitrates like isosorbide dinitrate, isosorbide mononitrate, or nitroglycerin.

Consuming these drugs alongside Viagra or Sildenafil can lead to a sudden drop in your blood pressure to the point that it might reach an unsafe level.

  • Guanylate cyclase stimulators like Riociguat.

Drinking these drugs, together with Viagra or Sildenafil, can result in a sudden drop in your blood pressure to the point that it might reach an unsafe level.

Moreover, consuming Viagra or Sildenafil with particular medications might increase your risk of adverse reactions from Viagra. This is because the levels of Viagra or Sildenafil in your body is raised. Some of these drugs are:

  • HIV drugs like indinavir, atazanavir, saquinavir, or atazanavir

Improved adverse reactions can range from dizziness, low blood pressure, or problems with vision. They can also result in erections that last longer than a reasonable period.

  • Particular antibiotics like erythromycin or clarithromycin

Improved adverse reactions can range from dizziness, low blood pressure, or problems with vision. They can also result in erections that last longer than a reasonable period.

  • Particular antifungals like itraconazole or ketoconazole

Improved adverse reactions can range from dizziness, low blood pressure, or problems with vision. They can also result in erections that last longer than the average period.

  • Alpha-blockers like tamsulosin, alfuzosin, terazosin, doxazosin, or silodosin.

Improved adverse reactions can range from fainting or low blood pressure.

  • Blood pressure drugs like amlodipine

Improved adverse reactions include a dip in blood pressure.

  • Other medications for erectile dysfunction like vardenafil, tadalafil, avanafil.

Improved adverse reactions can range from prolonged erections or low blood pressure.

You might also like to read about: